| Doctor Name: | GLEN B. DAVIS |
| NPI Number: | 1033395496 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 920 Sacramento Ave Spring Valley, CA - 919774938 |
| Business Phone Number: | 6193031964 |
| Business Fax Number: | |
| Mailing Address: | 447 N El Molino Ave, PASADENA |
| State: | CA |
| Postal Code: | 911011403 |
| Phone Number: | 6265778480 |
| Fax Number: | 6265778978 |
| NPI Enumeration Date: | 01/16/2008 |
| NPI Last Update Date: | 01/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 177F00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Lodging |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |